What is fraud

If you suspect someone may be committing fraud against us you should report it.

What we consider fraud

If people do something dishonest to get a payment or benefit from us they are committing fraud.

The Commonwealth Government defines fraud as ‘dishonestly obtaining a benefit, or causing a loss, by deception or other means’. It is a deliberate and intentional act.

We understand that most people are honest and try to do the right thing.

Fraud is not:

• an accident
• an error
• an oversight
• a misunderstanding

Examples of dishonest behaviour

Here are some examples of dishonest behaviour that may result in an ineligible payment which could be fraud.

Examples for Health Providers

• medical and allied health providers who submit treatment claims to us for services that they did not provide
• medical and allied health providers who deliberately claim for services that they know they are not eligible to be paid for as specified in our Schedule of Fees and Notes for providers

Examples for veterans and their families

Clients who deliberately provide false information or intentionally fail to report changes to circumstances that affect their payments or services are committing fraud.

A client may be committing fraud against us if they deliberately withhold information about:

• changes to their income or assets
• their employment, such as starting a new job or ceasing employment
• overseas travel
• changes to their relationship, such as starting a de facto relationship or leaving a partner
• the death of a client, so that another person may collect their payments after they pass

It is also fraud if a person:

• submits a travel claim to us where they knowingly did not travel, or they travelled a shorter distance than what they claimed
• intentionally uses their Veteran White Card for a health treatment that is not related to an accepted condition

The circumstances above do not apply to every payment or service.

Examples for our staff and contractors

Our staff and contactors may be committing fraud if they:

• collude with a client or health provider to secure a personal benefit
• falsify medical certificates
• intentionally redirect payments
• deliberately use a corporate credit card for personal purchases
• deliberately over-report their work hours
• falsify invoices for goods or services that were not provided

Examples for other persons

Other persons who may be committing fraud include:

• anyone who acts dishonestly to obtain a payment or service they are not entitled to
• anyone who uses grant funds for purposes other than the approved purpose

How to report suspected fraud to us

To report suspected fraud to us, you can:

• complete the online Reporting Fraud form
• contact us by phone or mail

Our staff and contractors may also make reports under the Public Interest Disclosure Act 2013 (PID) by following the processes on the PID Scheme page.

What information to provide

When reporting fraud to us you will need to let us know:

• all identifying details of the person you suspect may be committing fraud such as: their full name(s), gender, date of birth and address (if known)
• whether the alleged person(s) are a client, health provider, staff member of DVA, or other
• if it is about a provider, please include their discipline (e.g. physiotherapy, dentistry), provider number and business name (if known)
• the specific behaviour of the person which you suspect may be fraud, please provide as much detail as possible including time(s), date(s), location(s)
• how you became aware of the potential fraud
• any evidence that supports your report and/or shows the behaviour such as: emails, text messages, photographs, business or employment details and bank account details
• if you wish to remain anonymous or not
• if we can contact you to obtain further information regarding your report and how to contact you

Remaining anonymous

You can remain anonymous but it might be difficult for us to investigate. If you provide contact details we will protect your information in line with our obligations under the Privacy Act 1988. You can find out more about how we collect and use information on our privacy page.

The outcome of your report

Due to restrictions under the Privacy Act 1988 we cannot give you updates or details about our activities.

What we do with your report

We take all reports of suspected fraud seriously and assess every report.

Sometimes you may not see changes to someone’s situation. This can be because the information you give us does not always result in a change in a person’s payment or service.

In some cases we may be unable to take any further action. For example, we may find any of the following:

• the person you name does not receive a payment or service from us
• we cannot identify the person
• the information does not affect the payment or service the person receives
• the information does not match the person’s situation
• the information provided is not fraud against us where we are the victim

Where we find enough evidence of criminal behaviour we may refer matters to the Commonwealth Director of Public Prosecutions. This may lead to criminal charges and imprisonment.

Investigation of criminal offences can be a lengthy process and it may take several years before details become publicly known, if at all.

Not all investigations find enough evidence to prove a criminal offence. Even if someone receives an ineligible payment through a mistake or error, people must repay the money.

What we cannot investigate

Fraud against the general public

Unfortunately we cannot investigate suspected cases of fraud where we are not a victim.

If you or someone you know has been the victim of fraud committed by a member of the public you should report this to your local police.

Wearing medals

We are unable to investigate suspected cases of people fraudulently wearing service medals. You can report these concerns to the Australian Federal Police.

Fraud against other Government agencies

If you suspect someone may be committing fraud against Centrelink, Medicare or Child Support, you can report it to Services Australia.

If you have information about someone you think may be deliberately evading tax, you can report it to the Australian Taxation Office.

Unethical or unsafe behaviour by health providers

Unethical or unsafe behaviour by health providers may include:

• poor treatment, such as wrong or inadequate diagnosis or treatment
• not giving enough information, for example about a diagnosis or treatment
• inappropriate behaviour or relationship, such as a sexual relationship between a doctor and patient
• a doctor working under the influence of drugs or alcohol
• a health professional not having the appropriate qualifications

If you want to report a health provider’s unethical or unsafe behaviour, you can make a complaint to 1 of the following:

• the Australian Health Practitioner Regulation Agency
• a relevant peak professional body
• a state health complaints organisation